The State of Insulin Injection

What’s Being Researched Now

Oral Insulin-With the demise of Pfizer Inc.’s inhaled insulin, Exubera, the next holy grail for insulin delivery is oral insulin. The biggest problem in developing oral insulin is finding a way to protect the delicate insulin proteins from destruction by digestive system acids.

One current research approach is MonoSolRx Inc.’s edible film, which can be stuck on the inside of a patient’s cheek. The insulin-impregnated film dissolves, passing insulin directly into the circulatory system. The New Jersey-based company says that its film has worked well in monkeys and plans to begin human trials later this year in Europe.

Emisphere Technologies, also based in New Jersey, signed a deal with Novo Nordisk in late 2010 to develop an oral insulin. Neither company has stated how long it expects development to take. Another company, Entrega in Boston, is working on several orally taken drugs, including insulin.

Nanotechnology-Medical researchers at the University of California, San Francisco, are working on developing a “nano-box,” a tiny protective container with insulin-producing beta cells inside. Microscopic holes in the box are big enough to allow the cells to launch insulin into the bloodstream, but small enough to block entry by the body’s autoimmune system agents. (For a video peek at the work being done on this by UCSF Professor of Bioengineering Tejal Desai, go to http://www.youtube.com/watch?v=rY_siujVJEg.)

Long-term Insulin-Insulin injections for type 2s could drop to three per week, according to a study in the British medical journal The Lancet. The study shows that type 2s who received once-daily or thrice-weekly injections of degludec, a long-acting insulin, maintained blood levels similar to those of patients receiving daily doses of insulin glargine.

In the United States, about one in every three type 2 patients injects insulin at least once daily. One problem that healthcare providers run into when treating type 2s with insulin is getting them to adhere to an injection schedule that requires daily injections.

Degludec is being developed by Novo Nordisk. If approved for US sale, it would allow users to go 40 hours between injections-from 14 to 22 hours longer than they can with current long-acting basal insulins. The drug also can be mixed with other insulins. Novo is hoping to reach market by 2013.

Jet Injection-Although recent research shows that jet injection of insulin can work twice as fast as pens in lowering glucose, the technology remains cumbersome and requires a high level of patient commitment. So far, it has not been widely accepted in the marketplace. If smaller, easier-to-use devices can be developed, jet injection’s quicker and needle-less delivery could dramatically change consumer perceptions.

New on the Market

Smaller, Cost-saving Pen Needle Batches-UltiMed, which offers the only pen needles assembled in the United States, has announced that it is now providing a 50-count universal-fit pen needle.

Traditionally, pen needles are sold in batches of 100. After Walmart began selling private-label pen needles in 50-count boxes, however, UltiMed decided to enter the market with a matching offer.

The company says that as co-pays rise for many diabetes patients, the ability to buy pen needles in smaller quantities could help them financially. The 50-count product also opens the market to other suppliers and retailers who may want to follow Walmart’s lead.

Trends

Insulin Pens-Although up to 90 percent of people with diabetes in some European countries use insulin pens, US market penetration hovers around 20 percent. The higher cost of the pens compared to the traditional vial-and-syringe delivery system is the most often cited reason for low acceptance. In their favor, however, pens help users achieve better compliance and less waste of insulin because the doses are premeasured.

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